EAMON FALLER is a Galway doctor working with Médecins Sans Frontières/Doctors Without Borders (MSF ) in Homa Bay, Kenya. Eamon has been based in the country for the past six weeks and will stay on until December.
‘Pole sana’ is a Kiswahili phrase I’ve learned that is used to expresses sympathy in a uniquely quiet, respectful and gentle manner. Last week, feeling overwhelmed and a bit helpless, I said it to a woman who had just lost her son. She responded with grace, dignity and gratitude despite the tragedy that had just befallen her.
Her son was a strong 17-year-old who presented to our facility in Homa Bay with a new diagnosis of HIV; desperately short of breath and with catastrophically low blood oxygen levels. With time fast running out and no access to the type of diagnostics equipment I’d usually have at home, I began initiating every reasonable treatment that might have made a difference. I treated her son for bacterial pneumonia, HIV-related fungal pneumonia, blood clotting, TB, and gave him fluids, oxygen and nebulisers.
What he desperately needed was to be placed in an Intensive Care (ICU ) for a period of 24-48 hours; giving the much needed support to his failing organs and allowing the medicine the time it needed to work. I stood around feeling useless for the next few hours as I saw him slipping in and out of consciousness - trying to explain what I could about the situation to his distressed and devastated mother. He died shortly after.
It’s been, to say the least, an eventful six weeks since I had my mandatory pre-departure Dublin airport pint. I had been waiting for three months to go away with Médecins Sans Frontieres. Three months spent swinging swiftly between incredible excitement about my time ahead and sobering apprehension of the real challenges yet to come. When I got the call – Homa Bay County in Kenya was to be my eventual destination.
With a population of almost a million people, Homa Bay is an area about half the size of my native County Galway on the shores of Lake Victoria in Southwestern Kenya. The Homa Bay District Hospital where I work is a collection of buildings with 200 beds covering adult medicine, paediatrics and maternity care and serves as the main referral facility for those million aforementioned people living in the area. To put that in context, it is a hospital a third the size of that in Galway City serving more than four times the population.
The scale of the HIV problem in Homa Bay County is enormous. The most accurate figures available show a prevalence of 24.1% which represents the worst epidemic anywhere in Kenya.
About two thirds of these people are aware of their HIV status and most of these are leading happy, full and healthy lives thanks to anti-retroviral treatment. The MSF team here consists primarily of excellent and committed national staff alongside several international field staff like me. MSF’s goal here is two-pronged. Firstly and most importantly, we go out door-to-door to increase testing and diagnosis of HIV; aiming to get as many people on treatment as possible. Secondly, we work to improve in-patient services in the Kenyan Ministry of Health-run Homa Bay District Hospital which, as mentioned, is the main inpatient facility for almost 1 million people. My primary role for the next six months is to help with the second part, and contribute the skills that I have to do what I can.
In Homa Bay, services are desperately stretched. The ward I have been working on was built over 60 years ago to house a total of 24 beds. The 32 beds that are now crammed into ward contain an average of 44 patients at any given time. This means over half the patients, often with contagious illnesses, have to share a bed with other patients.
Half of the inpatients are people living with HIV which, in medical terms, tends to result in them being much more complex and generally sicker than the average patient. On top of that, one in five of these people will be diagnosed with TB.
Young people here often become critically ill and die due to largely preventable complications of HIV. So far I’ve seen many examples of this and sadly, I’ll undoubtedly see a lot more before my time is up here.
Unfortunately situations like these are the things that stick out in your mind. The disasters are generally more dramatic than the triumphs in medicine. The well-managed patient who walks out of the hospital and proceeds to live a long and happy life never weighs on anyone’s mind. No one dwells for long on the potential death or disability averted in the patient casually diagnosed with HIV in the community and started on anti-retrovirals.
But there are triumphs, and sometimes you can make a difference.
Earlier this week, a young woman turned up on our ward with severe malaria. Thanks to bedside tests provided by MSF, within an hour of arriving she had not only a diagnosis of malaria, but of HIV. This allowed us to get a precise idea of how advanced her HIV was and we could provide a basic screen of TB and the most serious HIV-associated infections. Within 24 hours she had been educated and counselled by specialized MSF-trained staff on her illness and its treatment as well as the need for her partner to get tested. Her life expectancy just increased from a sickly 3 to 5 years to a healthy 45 plus.
With more than 15,000 tests performed in the district by MSF monthly that’s a lot of averted disasters, avoided transmission and most importantly healthy, happy patient years!
I’m extremely grateful for the opportunity MSF have given me to be here. It’s wonderful seeing a tangible and sustainable difference being made.
Despite the obvious challenges and difficulties, as well as running dangerously low on factor 50 sun cream, I’m really looking forward to the next five months.
Médecins Sans Frontières/Doctors Without Borders (MSF ) is an independent international medical humanitarian organisation that delivers emergency aid in nearly 70 countries worldwide. MSF provides emergency medical care to people caught up in war, disasters and epidemics. For more see msf.ie